The Influence of Self-efficacy on The Relationship Between Depression and HIV-related Stigma with ART Adherence Among The Youth in Malawi

 Depression and HIV-related stigma, among other factors, have been inversely linked independently with adherence to antiretroviral therapy (ART) among the youth. However, the processes through which the various factors influence this relationship is not fully known. Guided by Social Action Theory, we examined the interactive mechanisms through which depression, HIV-related stigma, and self-efficacy influenced ART adherence and whether or not these relationships are moderated by gender. A total of 450 HIV-positive youth (13–24 years) in Malawi receiving ART participated in this cross-sectional study. Moderated mediation analyses were conducted using Hayes’ PROCESS macro 2.11 in SPSS. ART adherence was measured by pill count. Findings showed that self-efficacy mediated the effects of depression and stigma on ART adherence. The analyses also revealed that gender moderated both the direct and indirect influence of depression and stigma (via self-efficacy) on ART adherence. Furthermore, self-efficacy simultaneously mediated and moderated the relationship between stigma and ART adherence. The interactive mechanisms through which various factors influence ART nonadherence must be considered to design effective interventions. To reduce the impact of depression and stigma on ART adherence, medication self-efficacy should be bolstered while taking gender in consideration. Keywords: Adolescent, Antiretroviral adherence, Malawi, Moderated mediation, Social action theory, Youth Abstrak Pengaruh Efikasi Diri Terhadap Hubungan antara Depresi dan Stigma HIV dengan Kepatuhan Terapi ART pada Remaja di Malawi. Depresi dan stigma HIV, di antara faktor-faktor lain, berhubungan terbalik secara independen dengan kepatuhan terapi antiretroviral (ART) pada remaja. Akan tetapi, dalam prosesnya faktor yang memengaruhi hubungan ini belum sepenuhnya diketahui. Berdasarkan Teori Perilaku Sosial, penelitian ini dilakukan bertujuan untuk mengkaji mekanisme interaktif depresi, stigma HIV, dan efikasi diri yang memengaruhi kepatuhan ART, dan untuk mengetahui apakah hubungan ini dimoderasi oleh gender atau tidak. Sebanyak 450 remaja dengan HIV-positif (13–24 tahun) di Malawi yang menerima ART ikut berpartisipasi dalam penelitian potong lintang ini. Analisis mediasi moderated dilakukan dengan menggunakan Hayes 'PROCESS macro 2.11 pada SPSS. Kepatuhan ART diukur menggunakan jumlah pil. Hasil penelitian menunjukkan bahwa efikasi diri memediasi efek depresi dan stigma pada kepatuhan ART. Hasil analisis juga mengungkapkan bahwa jenis kelamin memoderasi pengaruh langsung dan tidak langsung dari depresi dan stigma (melalui efikasi diri) terhadap kepatuhan ART. Lebih lanjut,efikasi diri secara bersamaan mediasi dan moderasi hubungan antara stigma dan kepatuhan ART. Mekanisme interaktif dengan berbagai faktor yang memengaruhi ketidakpatuhan ART harus dipertimbangkan untuk merancang intervensi yang efektif. Untuk mengurangi dampak depresi dan stigma terhadap kepatuhan ART, efikasi diri pengobatan harus didukung saat mempertimbangkan jenis kelamin. Kata kunci: Kepatuhan antiretroviral, Malawi, Mediasi tingkat menengah, Teori Perilaku Sosial, Remaj

Licit and illicit substance use among persons who inject drugs and the association with subsequent suicidal attempt

AIM: To estimate associations between recent licit and illicit substance use and subsequent suicide attempt among people who inject drugs (PWID). DESIGN: Secondary analysis of longitudinal data from a prospective cohort study of PWID followed bi-annually between 2004 and 2011. SETTING: Montréal, Canada. PARTICIPANTS: Seven hundred and ninety-seven PWID who reported injection drug use in the previous 6 months, contributing to a total of 4460 study visits. The median number of visits per participant was five (interquartile range: 3-8). MEASUREMENTS: An interviewer-administered questionnaire eliciting information on socio-demographic factors, detailed information on substance use patterns and related behaviours, mental health markers and suicide attempt. The primary exposure variables examined were past-month use of alcohol [heavy (≥ 60 drinks); moderate (one to 59 drinks); none], sedative-hypnotics, cannabis, cocaine, amphetamine and opioids [regular (≥ 4 days); occasional (1-3 days); none]. The outcome was a binary measure of suicide attempt assessed in reference to the previous 6 months. FINDINGS: In multivariate analyses, a positive association was found among licit substances between heavy alcohol consumption [adjusted odds ratio (AOR) = 2.05; 95% confidence interval (CI) = 1.12-3.75], regular use of sedative-hypnotics (AOR = 1.89; 95% CI = 1.21-2.95) and subsequent attempted suicide. Among illicit substances, occasional use of cannabis (AOR = 1.84; 95% CI = 1.09-3.13) had a positive association with subsequent suicide attempt. No statistically significant association was found for the remaining substances. CONCLUSION: Among people who inject drugs, use of alcohol, sedative-hypnotics and cannabis, but not cocaine, amphetamine or opioids, appears to be associated with an increased likelihood of later attempted suicide

Modeling of randomized hepatitis C vaccine trials: Bridging the gap between controlled human infection models and real-word testing

Global elimination of chronic hepatitis C (CHC) remains difficult without an effective vaccine. Since injection drug use is the leading cause of hepatitis C virus (HCV) transmission in Western Europe and North America, people who inject drugs (PWID) are an important population for testing HCV vaccine effectiveness in randomized-clinical trials (RCTs). However, RCTs in PWID are inherently challenging. To accelerate vaccine development, controlled human infection (CHI) models have been suggested as a means to identify effective vaccines. To bridge the gap between CHI models and real-world testing, we developed an agent-based model simulating a two-dose vaccine to prevent CHC in PWID, representing 32,000 PWID in metropolitan Chicago and accounting for networks and HCV infections. We ran 500 trial simulations under 50 and 75% assumed vaccine efficacy (aVE) and sampled HCV infection status of recruited in silico PWID. The mean estimated vaccine efficacy (eVE) for 50 and 75% aVE was 48% (SD ± 12) and 72% (SD ± 11), respectively. For both conditions, the majority of trials (∼71%) resulted in eVEs within 1 SD of the mean, demonstrating a robust trial design. Trials that resulted in eVEs >1 SD from the mean (lowest eVEs of 3 and 35% for 50 and 75% aVE, respectively), were more likely to have imbalances in acute infection rates across trial arms. Modeling indicates robust trial design and high success rates of finding vaccines to be effective in real-life trials in PWID. However, with less effective vaccines (aVEs∼50%) there remains a higher risk of concluding poor vaccine efficacy due to post-randomization imbalances

Parental Substance Abuse As an Early Traumatic Event. Preliminary Findings on Neuropsychological and Personality Functioning in Young Drug Addicts Exposed to Drugs Early.

open5noParental substance use is a major risk factor for child development, heightening the risk of drug problems in adolescence and young adulthood, and exposing offspring to several types of traumatic events. First, prenatal drug exposure can be considered a form of trauma itself, with subtle but long-lasting sequelae at the neuro-behavioral level. Second, parents’ addiction often entails a childrearing environment characterized by poor parenting skills, disadvantaged contexts and adverse childhood experiences (ACEs), leading to dysfunctional outcomes. Young adults born from/raised by parents with drug problems and diagnosed with a Substance Used Disorder (SUD) themselves might display a particularly severe condition in terms of cognitive deficits and impaired personality function. This preliminary study aims to investigate the role of early exposure to drugs as a traumatic event, capable of affecting the psychological status of young drug addicts. In particular, it intends to examine the neuropsychological functioning and personality profile of young adults with severe SUDs who were exposed to drugs early in their family context. The research involved three groups, each consisting of 15 young adults (aged 18–24): a group of inpatients diagnosed with SUDs and exposed to drugs early, a comparison group of non-exposed inpatients and a group of non-exposed youth without SUDs. A neuropsychological battery (Esame Neuropsicologico Breve-2), an assessment procedure for personality disorders (Shedler-Westen Assessment Procedure-200) and the Symptom CheckList-90-Revised were administered. According to present preliminary results, young drug addicts exposed to drugs during their developmental age were characterized by elevated rates of neuropsychological impairments, especially at the expense of attentive and executive functions (EF); personality disorders were also common but did not differentiate them from non-exposed youth with SUDs. Alternative multi-focused prevention and intervention programs are needed for children of drug-misusing parents, addressing EF and adopting a trauma-focused approach.openParolin, Micol; Simonelli, Alessandra; Mapelli, Daniela; Sacco, M.; Cristofalo, P.Parolin, Micol; Simonelli, Alessandra; Mapelli, Daniela; Sacco, M.; Cristofalo, P

Agent-Based Model of Combined Community- and Jail-Based Take-Home Naloxone Distribution

Importance: Opioid-related overdose accounts for almost 80 000 deaths annually across the US. People who use drugs leaving jails are at particularly high risk for opioid-related overdose and may benefit from take-home naloxone (THN) distribution. Objective: To estimate the population impact of THN distribution at jail release to reverse opioid-related overdose among people with opioid use disorders. Design, Setting, and Participants: This study developed the agent-based Justice-Community Circulation Model (JCCM) to model a synthetic population of individuals with and without a history of opioid use. Epidemiological data from 2014 to 2020 for Cook County, Illinois, were used to identify parameters pertinent to the synthetic population. Twenty-seven experimental scenarios were examined to capture diverse strategies of THN distribution and use. Sensitivity analysis was performed to identify critical mediating and moderating variables associated with population impact and a proxy metric for cost-effectiveness (ie, the direct costs of THN kits distributed per death averted). Data were analyzed between February 2022 and March 2024. Intervention: Modeled interventions included 3 THN distribution channels: community facilities and practitioners; jail, at release; and social network or peers of persons released from jail. Main Outcomes and Measures: The primary outcome was the percentage of opioid-related overdose deaths averted with THN in the modeled population relative to a baseline scenario with no intervention. Results: Take-home naloxone distribution at jail release had the highest median (IQR) percentage of averted deaths at 11.70% (6.57%-15.75%). The probability of bystander presence at an opioid overdose showed the greatest proportional contribution (27.15%) to the variance in deaths averted in persons released from jail. The estimated costs of distributed THN kits were less than $15 000 per averted death in all 27 scenarios. Conclusions and Relevance: This study found that THN distribution at jail release is an economical and feasible approach to substantially reducing opioid-related overdose mortality. Training and preparation of proficient and willing bystanders are central factors in reaching the full potential of this intervention.</p

Pathways from witnessing community violence to mental health problems among South African adolescents

The intersection of violence exposure and mental health problems is a public health crisis for South African (SA) adolescents. Understanding the impact of community violence on adolescent mental health can inform future interventions. Objectives. To assess pathways between community violence exposure and internalising and externalising problems in SA adolescents receiving mental healthcare, and the roles of parent and peer relationships in these associations. Methods. Participants (N=120 parent-adolescent pairs) were recruited from four mental health clinics in Western Cape Province to participate in a pilot test of a family-based HIV prevention study. Adolescents reported on their exposure to community violence, parental attachment, peer support of risk behaviour, and mental health. Parents reported on adolescents' internalising and externalising mental health problems. Participants received transport money (ZAR30 = USD3) and a shopping voucher or cash (ZAR50 = USD5) for their time. Results. Adolescents were 12 - 18 years old (mean (standard deviation) 14.39 (1.82) years), 53% were male, and 67% and 33% reported black African and mixed-race ethnicity, respectively. Parents were 94% female and reported an average monthly income of ZAR3 973 (USD397)

Longitudinal Determinants of Consistent Condom Use by Partner Type Among Young Injection Drug Users: The Role of Personal and Partner Characteristics

We investigated the longitudinal influence of individual-, relationship- and social-level factors on condom use by partner type among young injections drug users (IDUs) enrolled in the Collaborative Injection Drug Users Study-III/Drug Users Intervention Trial (CIDUS-III/DUIT) from 2002 to 2004. Based on longitudinal analysis using generalized estimating equations (GEE), consistent condom use with main partners was more commonly reported among males and those with greater self-efficacy for condom use; main partner’s desire for pregnancy and needle sharing were negatively associated with consistent condom use. Among those with casual partners, having fewer sex partners was associated with consistent condom use. Positive attitudes toward condom use and partner norms supporting condom use were associated with greater consistent condom use with both partner types. These findings suggest that intervention strategies targeting individual- and partner-level factors may provide avenues for intervening upon sexual risks among young IDUs